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Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

Bankar SS, Bakshi GK, Prakash G, Sable NP - Indian J Urol (2015 Jul-Sep)

Bottom Line: Radical cystectomy is the standard treatment for muscle invasive bladder cancer.Lymphocele is a common sequalae of pelvic lymphadenectomy.Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, Maharashtra, India.

ABSTRACT
Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

No MeSH data available.


Related in: MedlinePlus

Lymphocele compressing the catheterized conduit
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Figure 2: Lymphocele compressing the catheterized conduit

Mentions: A 50-year-old lady presented to the outpatient department of our hospital with symptoms of abdominal distension and pain associated with gradually decreasing urine output from the ileal conduit. She had undergone radical cystectomy and bilateral pelvic lymphadenectomy with ileal conduit reconstruction for muscle invasive bladder cancer 5 months earlier. There was history of a similar episode of ileal conduit obstruction being relieved by catheterizing the conduit 1 month back. Ultrasonography (USG) of the abdomen showed bilateral mild hydroureteronephrosis with distended ileal conduit. Computerized tomography (CT) scan of the abdomen with contrast study of the ileal conduit showed a large lobulated collection in the pelvis that was causing an upward displacement of the conduit and subsequent obstruction to outflow [Figures 1 and 2]. A diagnosis of pelvic lymphocele was made on percutaneous aspiration of approximately 1.5 L of straw-colored fluid, which, on cytological examination, showed lymphocyte-rich effusion and creatinine levels matching those of serum. Symptoms were relieved after aspiration of the lymphocele. However, the lymphocele reformed with recurrence of symptoms within 2 days. A pigtail catheter was then placed in situ under CT imaging guidance. It was removed after 2 weeks as the output was minimal. A repeat USG was performed on follow-up, which showed minimal residual fluid in the pelvis and complete resolution of hydroureteronephrosis. The patient has remained asymptomatic since aspiration of lymphocele and has normal functioning urostoma after a follow-up of 1 year.


Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

Bankar SS, Bakshi GK, Prakash G, Sable NP - Indian J Urol (2015 Jul-Sep)

Lymphocele compressing the catheterized conduit
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495504&req=5

Figure 2: Lymphocele compressing the catheterized conduit
Mentions: A 50-year-old lady presented to the outpatient department of our hospital with symptoms of abdominal distension and pain associated with gradually decreasing urine output from the ileal conduit. She had undergone radical cystectomy and bilateral pelvic lymphadenectomy with ileal conduit reconstruction for muscle invasive bladder cancer 5 months earlier. There was history of a similar episode of ileal conduit obstruction being relieved by catheterizing the conduit 1 month back. Ultrasonography (USG) of the abdomen showed bilateral mild hydroureteronephrosis with distended ileal conduit. Computerized tomography (CT) scan of the abdomen with contrast study of the ileal conduit showed a large lobulated collection in the pelvis that was causing an upward displacement of the conduit and subsequent obstruction to outflow [Figures 1 and 2]. A diagnosis of pelvic lymphocele was made on percutaneous aspiration of approximately 1.5 L of straw-colored fluid, which, on cytological examination, showed lymphocyte-rich effusion and creatinine levels matching those of serum. Symptoms were relieved after aspiration of the lymphocele. However, the lymphocele reformed with recurrence of symptoms within 2 days. A pigtail catheter was then placed in situ under CT imaging guidance. It was removed after 2 weeks as the output was minimal. A repeat USG was performed on follow-up, which showed minimal residual fluid in the pelvis and complete resolution of hydroureteronephrosis. The patient has remained asymptomatic since aspiration of lymphocele and has normal functioning urostoma after a follow-up of 1 year.

Bottom Line: Radical cystectomy is the standard treatment for muscle invasive bladder cancer.Lymphocele is a common sequalae of pelvic lymphadenectomy.Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Marg, Parel, Mumbai, Maharashtra, India.

ABSTRACT
Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

No MeSH data available.


Related in: MedlinePlus